Erectile Dysfunction—causes, treatments, and myths

Erectile dysfunction (ED) is more common than most people realize—and far more treatable than many expect. Whether it happens occasionally or becomes a persistent issue, ED can affect confidence, relationships, and overall quality of life. But understanding what causes it, what treatment options are available, and which “truths” are actually myths can help you take control of your sexual health.

Mount Nittany Health urologist Dr. Stephen Phillips offers expert insight, practical solutions, and reassurance for those navigating erectile dysfunction.

What is erectile dysfunction?

Erectile dysfunction is the consistent or repeated inability to get or keep an erection firm enough for sexual activity. Men may experience occasional difficulty because of stress or fatigue, but when the issue becomes regular, it may signal an underlying condition that requires attention.

Health care providers typically diagnose ED when problems persist for at least three months. ED affects millions of men and can occur at any age, and becomes more common as you get older. Fortunately, erectile dysfunction is highly treatable, and effective options are available for most men.

Common causes of erectile dysfunction

ED doesn’t have a single cause. Instead, it can result from a combination of physical, emotional, and lifestyle factors.

“The most common and significant cause of ED we see is vascular,” Dr. Phillips explained. “As men age, wear and tear on the vascular system affects how well blood flows through the body, including to erectile tissues. Hypertension, diabetes, and tobacco use are major contributors to vascular damage that impacts erections.”

“ED isn’t just about achieving an erection—difficulty maintaining one or only having partial erections are often vascular-related too,” he added.

Dr. Phillips shared that other contributors include:

• Neurologic conditions: “Diabetes can also damage small nerves, and surgeries or injuries affecting the spine or pelvic region can interfere with erectile function,” Dr. Phillips said.
• Medications: “Some blood pressure, psychiatric, or neurological medications can impact erections. Sometimes it’s the medication, but often, the same underlying condition that requires medication is the root cause.”
• Psychological factors: “Stress, mood, grief, or relationship issues often make ED worse. We frequently see ED worsen after illness, major life changes, or even when a partner is going through something stressful.”
• Tissue injury: “Over time, microscopic damage to penile tissues can accumulate. As erections weaken, this damage builds and can spiral into more significant dysfunction.”

“Rarely is there just one cause,” he emphasized. “Most men experience a mix of factors that build up over time.”

5 ED myths and the facts behind them

Misinformation about erectile dysfunction causes stigma about the condition, preventing many men from seeking appropriate help. Here are five common erectile dysfunction myths and the facts you should know.

Myth 1: “Only older men get ED.”

Age does increase risk, but men of all ages can experience ED. Younger men often experience ED because of psychological factors, lifestyle choices, or underlying health conditions.

Myth 2: “It’s all in your head.”

Psychological factors can play a role, but most cases involve a physical component. Telling someone their ED is “all mental” ignores the complex interaction between physical and emotional health.

Myth 3: “Testosterone supplements fix everything.”

“Low testosterone does sometimes play a role,” Dr. Phillips said, “but it’s rarely the main cause of ED. Many men with normal testosterone levels still have ED, and testosterone therapy usually isn’t the solution unless labs confirm a deficiency.”

Myth 4: “If you can get an erection sometimes, you don’t have ED.”

ED can vary based on stress, sleep, alcohol, or health changes. Many men maintain some erectile function while still meeting criteria for ED diagnosis. Erections that aren’t firm enough for intercourse, don’t last long enough, or occur inconsistently still count and may benefit from treatment.

Myth 5: “Viagra works instantly and for everyone.”

“ED meds don’t give you an erection—they help your body do what it’s supposed to,” Dr. Phillips explained. “They require sexual stimulation and don’t work immediately.”

“The big issue we run into frequently with these meds is that the food you eat the day (or night) you take them can directly negatively impact how well it works,” he continued. “Foods with a lot of fat make the medication not work as well. Viagra, specifically, is almost half of the dose if taken with a very heavy meal.”

“They’re helpful for many men, but not perfect—and minor side effects like headaches or muscle aches are common,” he added.

How to treat ED

Effective treatments are available for nearly every man with ED. The right approach depends on your symptoms, health history, and preferences.

ED treatment options may include:

• PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). These medications work by increasing blood flow to the penis during sexual arousal. Success rates range from 60-80%, depending on the person and the underlying causes.
• Hormone therapy, if blood tests confirm low testosterone
• Penile injections or suppositories
• Vacuum erection devices
• Penile rings or penile occlusion rings. “They work really well for ED issues that are predominantly trouble maintaining the erection,” Dr. Phillips explained. “They are silicon rings that go around the base of the penis or the penis and scrotum and help with maintaining the erection.”
• Penile implants are typically only considered if other treatments fail
• Counseling or therapy to address anxiety, depression, or relationship concerns
• Lifestyle changes. “Heart-healthy eating, regular exercise, and quitting tobacco are always helpful,” Dr. Phillips noted.

A combination of treatments often offers the most success. “We’re honest with patients. No one is 20 again, but the goal is functional and satisfying results. Most men can reach that with the right combination of treatments,” Dr. Phillips said. “We have many options worth exploring, and the results are often better than expected.”

When to talk to a doctor

If ED is affecting your life—physically or emotionally—don’t wait. Schedule a visit with your health care provider if:

• ED happens more than occasionally
• You have noticed changes in sexual desire
• You are struggling with anxiety or relationship stress related to performance
• You have other symptoms, such as fatigue, weight gain, or mood shifts

Although discussing ED can feel uncomfortable, it is a common and treatable health condition. Erectile dysfunction is highly manageable with proper care, and early intervention often leads to better outcomes.

“Don’t be afraid to speak up,” Dr. Phillips encouraged. “ED and other reproductive or urinary concerns are more common than people realize. Primary care providers can often get you started with treatment or refer you to a specialist if needed, and many treatments are more affordable now, too.”

ED is a medical condition, not a personal shortcoming. With the right care, most men see significant improvement.

If you are concerned about ED or other changes in sexual health, schedule an appointment with one of our primary care providers or urology specialists.